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PubMedDate not supplied

Sideways dislocation of the temporomandibular joint meniscus: the edge sign.

Seventy temporomandibular joint arthrograms of 49 patients with symptoms of internal joint derangement were reviewed. Twenty-three of these arthrograms (33%) were abnormal but atypical for anteriorly dislocated meniscus. The lower temporomandibular joint space had a well-defined edge located inferiorly, which was attributed to pressure from a sideways-dislocated meniscus. We called this appearance the "edge sign." Seven patients with radiologically apparent sideways dislocation were operated on. The meniscus was dislocated laterally in six and medially in one. The incidence of irreducibility and perforation was higher in sideways-dislocated than in anteriorly dislocated menisci.

Adolescent↗
PubMed1987

[Study of the tracking movement in dislocation of the acromioclavicular joint].

Tracking movement in the scapular plane and electromyograms from the upper trapezius, rhomboideus, middle deltoideus, and pectoralis major muscles were analyzed during the movement in ten subjects who had grade II dislocation of the acromioclavicular joint. The purpose of this study was to clarify whether or not the dislocation of the acromioclavicular joint affects the rhythmic movement of the shoulder joint, and to evaluate objectively fatigue on the shoulder girdle of the dislocated side. The dislocation of acromioclavicular joint affects the fast rhythmic movement of the shoulder joint from 90 degrees elevation, but does not affect the movement from hanging position. The amplitude of electromyograms of some muscles on the dislocated side is greater than that on the sound side in the same movement of the shoulder joint. This increase of action potential on the dislocated side is thought to produce fatigue.

Acromioclavicular Joint↗
PubMed1986

Adult elbow dislocations: mechanism of instability.

From these data it appears reasonable to advocate open repair of fracture dislocations of the elbow joint, particularly those associated with radial head fractures. In these instances improved functional results can be anticipated. In simple elbow dislocations in adults, it is possible that open repair of the medial collateral ligament will produce improved functional results. However, the data, although suggestive, are not conclusive at this time. It is our belief that the indications for surgery in elbow dislocations can be summarized as follows. Surgical intervention is indicated if spontaneous redislocation occurs, unless the arm is flexed above 90 degrees. Surgery is indicated if a spontaneous redislocation of the elbow dislocation occurs with the arm in plaster. Surgical repair of the medial collateral ligament is indicated in all instances of fracture dislocations of the elbow, particularly those associated with radial head fractures. In adult simple elbow dislocations surgical repair of the anterior oblique ligament certainly does not impair elbow function at follow-up and indeed may lead to better results.

Adult↗
PubMed1985

Current concepts in the diagnosis and management of acromioclavicular dislocations.

Not all complete dislocations of the acromioclavicular joint should be treated by one method alone. A classification of acromioclavicular dislocation is presented and is based upon the pathology of the injury. Grade I sprain results from a mild force that causes tearing of only a few fibers of the acromioclavicular joint. Grade II sprains are caused by a moderate force with a rupture of the capsule and acromioclavicular ligament. Grade III sprains result from a severe force that ruptures both the acromioclavicular and coracoclavicular ligaments and causes a dislocation of the joint. Grade IV dislocation may be associated with an avulsion fracture of the coracoclavicular ligament from the inferior lateral clavicle, severe tearing or other injury to the soft-tissue envelope about the lateral clavicle, or a buttonhole injury of the lateral clavicle. Grade V dislocation refers to a posterior displacement of the lateral clavicle from any cause, while Grade VI relates to an inferior lateral clavicle displacement. Grades I, II, and most Grade III injuries can be treated conservatively. The indications for open treatment of Grade III injuries are reviewed. It is recommended that Grade IV and most Grade V and VI dislocations be managed with open methods.

Acromioclavicular Joint↗
PubMed1985

[Congenital anterior dislocation of the hip].

An apparently congenital antero-superior hip dislocation is identified during surgery. With reference to this case, three possible clinical courses for congenital hip dislocations are outlined: As a rule full recovery is most frequent. However, a posterior dislocation which is persistent tends to become postero-superior upon weight-bearing. Anterior dislocations as well as antero-superior subluxation appear to be rather common. Both pathology and the CAT scan attest to this fact. Extension, which is a true dislocating position for a retracted hip in adduction anc rotated externally, is probably responsible for such an evolution. Anterior dislocation and especially antero-superior subluxation are frequent findings which can be explained anatomically. The eventual complications of the antero-superior wall of the acetabulum resulting from these, will be the objective of most of the usual treatments for residual hip dysplasia.

Female↗
PubMed1979

Circulatory and vascular changes in the hip following traumatic hip dislocation.

An experimental study of the extraosseous and intraosseous vascular and circulatory changes following traumatic hip dislocation in dogs and rabbits is reported. The observations were made by dissection, angiography and histology following posterior dislocation and reduction at varying intervals. Traumatic dislocation of the hip causes extraosseous circulatory disturbance in the hip resulting in intraosseous circulatory deficiency in the femoral head. The sites of the vascular lesions are the extraosseous branches of the femoral circumflex arteries and their extraosseous branches of the epiphyseal and metaphyseal arteries and the retinacular artery of the circulus vasculosus articularis. The types of the vascular damage are irreversible tear of the minority of vessels along the ruptured capsule and teres ligament, and the compression, traction and spasm of the majority of intact vessels which are reversible by early reduction. In prolonged dislocation the circulatory disturbance persists or worsens due to additional pathological changes such as posttraumatic inflammatory changes, fixed deformity in the dislocated position, thrombosis, fibrosis and occlusion of vessels which may eventually cause an ischemic necrosis of the femoral head. Early reduction within several hours after dislocation restores nearly normal regional anatomy and relieves vessels from compression, traction or spasm and restores extra and intraosseous circulation. It also prevents or minimizes thrombosis, fibrosis and occlusion of vessels and avascular necrosis of the femoral head.

Animals↗
PubMed1984

[Traumatic shoulder dislocation. Late functional results with reference to the frequency of redislocation].

This study reports on the after-examination of 86 out of 107 patients with primary shoulder dislocation. Of greatest interest was the question which period of immobilisation would yield the best results. The most frequent type of dislocation was the subcoracoid position in 62% of all cases. In 44% the dislocations were associated with fractures especially of the greater tuberosity. The greatest number of dislocations occurred between 61 and 80 years of age (= 42%). The second highest number was found between 21 and 40 years of age (= 29%). In 47% of all cases the shoulder was immobilised for a week, in 40% between one and two weeks and in 13% for more than two weeks. The incidence of recurrence was 15% (13 patients). In 8 cases (= 9%) a recurrent dislocation of the shoulder resulted, whereas in 5 cases (= 6%) only one relapse occurred due to a repeated intense trauma. The function of the injured shoulder is most significantly impaired and rendered worse by the factors: higher age (greater than 41 years) and associated fractures. The duration of immobilisation itself has neither a significant influence on posttraumatic function of the shoulder nor on the incidence of recurrence. Therefore, an uncomplicated dislocation of the shoulder should be immobilised for a short period only. However, in cases of associated fractures, immobilisation will be necessary for a longer time.

Adolescent↗
PubMed1984

Acute shoulder dislocations: factors influencing diagnosis and treatment.

The Bankart lesion is the most important single causative factor in traumatic anterior shoulder dislocations (85%). Capsular rupture occurs in approximately 15% of traumatic anterior shoulder dislocations and may or may not heal with redundancy. If so, recurrent dislocation in possible. Surgical repair of traumatic anterior dislocations requires that the capsule be opened for correct identification of the lesion and correct repair. Limitation of external rotation is not necessary for repair of anterior shoulder dislocations and should be considered as an untoward complication. While multiple procedures are available, all of which may be satisfactory at one time or another, no one procedure repairs all traumatic anterior shoulder dislocations.

Arthrography↗
PubMedDate not supplied

Dislocation following total hip arthroplasty. Management by special brace in selected patients.

Dislocation after total hip arthroplasty (THA) occurs in 1%-3% of the cases reported in the literature. Recurrent dislocations due to malpositioned components should be treated by revision arthroplasty. Dislocated hips that have optimally positioned components but weak abductors can be treated by a special brace that prevents extremes of flexion, adduction, and rotation. Two hundred and eighty-nine total hip arthroplasties were performed from 1975 to 1981. Nine patients, all of whom had optimal position of components and the brace treatment, had dislocations. In one patient who had a spastic muscle disorder the brace was used as prophylaxis. The short chair-back brace has a lateral joint with thigh cuff. The joint can be locked at a particular position to give the desired movement of the hip joint. The brace, applied after the second dislocation, is worn for six to nine months. Excellent results were obtained in nine patients. One patient is still using the brace. The brace is light and can be worn under normal clothing; ordinary activities are easily performed by patients wearing the brace. Patients should be trained to avoid positions and activities that predispose to dislocation.

Aged↗
PubMed1982

Incidence of shoulder dislocation in Sweden.

Shoulder joint dislocations collected from a randomized population were investigated in Sweden, wherein nearly 50% of people with primary dislocations never visit hospitals nor are treated by a physician. Thus information obtained from surgically treated patients is of limited value because cases requiring operative repair represent only a small and selected percentage of the population. The incidence of shoulder dislocation in people from 18 to 70 years of age was at least 1.7% and was three times more common in males. Spontaneous healing of recurrent dislocations in a period of many years was not uncommon. Shoulder joint dislocation was more common among children than was generally appreciated, with the prognosis usually good. Recurrences of primary dislocations in people 15 to 25 years of age were not as frequent as was expected.

Adolescent↗
PubMed1978

Anterior subglenoid dislocation of the shoulder in an infant following pneumococcal meningitis.

A 7 1/2-month-old boy had an anterior inferior dislocation of the shoulder. Dislocations of the shoulder in infants have previously been reported, and were either congenital dislocations with associated anomalies of the glenohumeral joint with dislocations from Erb's palsy or septic arthritis. In the present case, dislocation of the shoulder was associated with spastic brain damage. The marked spasticity of the deltoid muscle may have been the deforming force. Capsular and subscapularis plication plus recession of the deltoid corrected the deformity and prevented further dislocations.

Humans↗
PubMed1982

The functional cost of dislocation following total hip arthroplasty.

The consequences of dislocation following total hip arthroplasty were assessed using quantitative gait analysis. As a preliminary study, a review of 18 patients having undergone hip arthroplasty without dislocation provided as understanding of the improvement in gait in the first two years after surgery. Seven patients with a single dislocation and six patients with multiple dislocations were compared with patients matched according to age and preoperative gait characteristics and who experienced an uncomplicated recovery following hip arthroplasty. One year after surgery patients with a single dislocation could not be differentiated from the matched patients with respect to gait velocity and single limb support time. However, patients, with multiple dislocations walked significantly slower and had a significantly decreased single limb support time in the involved extremity than their respective matched patients.

Aged↗
PubMed1994

Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management.

Twenty-five dislocations occurred after 561 total hip arthroplasties performed by the author from 1971 to 1992. Acetabular shell and liner loosening must be differentiated from true dislocations. The dislocation rate of 5.49% in female patients was higher than the 2.8% rate in male patients. The 4.76% rate after 84 total hip revisions was slightly higher than the 3.98% rate after 477 primary replacements. No dislocations occurred using the anterolateral approach for 53 patients. Dislocation rates varied using different prosthetic systems for 508 patients who had the posterolateral approach used. Femoral prostheses with larger neck diameters were more prone to dislocation. These differences were not statistically significant with the sample sizes used, according to the chi square test for equality of proportions. Fluoroscopy aided reduction of one multiplanar recurrent case. Single hip spica abduction casts with and without knee hinges used for three to four months, along with abduction isometric exercises, led to stability in six recurrent cases.

Aged↗
PubMed1993

Isolated fracture-dislocation of the fourth carpometacarpal joint. A report of two cases.

Dislocations and fracture-dislocations of isolated and multiple carpometacarpal (CMC) joints are rare injuries that usually result from the impact of a clenched hand on an immobile object. Various authors have presented combinations of dislocations of any or all of the CMC joints. Isolated fracture-dislocation of the fourth CMC joint, however, is either exceedingly rare or highly underreported. Two cases of isolated fracture-dislocation of the fourth CMC joint are presented here: in both, the appearance of the hand suggested a fracture-dislocation of the CMC joint, and the isolated lesion was confirmed at the time of surgery. Both patients were treated with open reduction and internal fixation and had good results at 2 years.

Adult↗
PubMed1993

[Experimental study of dislocations of the scapulohumeral joint].

One may produce easily an experimental dislocation (anterior or erecta) of the scapulohumeral joint. The authors discuss, the experimental model then they describe the anatomical lesion produced through the experimental dislocation of 32 shoulders and the correlation observed after RMI assessment of 24 recurrent dislocations. The tear of the inferior glenohumeral ligament is constant, in 20 per cent of the cases the tear lies on the anterior aspect of the glenoid, in the other cases the tear was found on its humeral side. Whatever the situation of the tear of the inferior glenohumeral ligament, the lesion of the labrum was constant. The erecta dislocation was produced with the same movement but with a particular tear of the glenohumeral ligament: the tear was longitudinal. The experimental dislocation needs, in 7 or 8 cases, a desinsertion of the deep aspect of the rotator cuff. The Hill Sachs lesion occurs when the humerus falls along the chest wall after the dislocation. In 50 per cent of the patients, MRI shows modifications of the cuff which are compatible with our results. Hills Sachs lesions appear to be constant after MRI examination.

Humans↗
PubMed1996

Acute dislocations of the distal radioulnar joint.

An injury to the DRUJ can occur in association with almost any fracture of the forearm or as an isolated phenomenon. A dislocation of this joint may be simple or complex. Constant awareness must be maintained during treatment of injuries of the wrist, forearm, and elbow if common pitfalls are to be avoided. Failure to diagnose and treat a complex DRUJ dislocation will lead to chronic, persistent subluxations or dislocations, or both, and to symptomatic osteoarthrosis. Failure to recognize a simple dislocation of the DRUJ associated with a fracture of the forearm may result in inappropriate or inadequate immobilization of the dislocated joint after internal fixation of the fracture. As a consequence, the injured TFCC may not heal, leading to recurrent post-operative instability. After either a simple or a complex dislocation of the DRUJ has been recognized, the treatment is relatively straightforward and rewarding. Despite the severity of these injuries, with proper diagnosis and management most patients will have a satisfactory outcome.

Acute Disease↗
PubMed1995

[Lisfranc's fracture-dislocations].

PURPOSE OF THE STUDY: Classicaly Lisfranc fractures dislocations are unusual. Our study is based on 69 observations from January 1974 to January 1992. MATERIAL AND METHODS: Fractures occured during tremendous impacts with a sex ratio of two men for one woman. The authors insist on the diagnostic value of good quality standard x-rays. Using Trillat's classification, we had 19 homolateral spatular fractures dislocations, 22 homolateral columno-spatular, 8 divergent columnar and 19 divergent columno spatular. A dislocation was reduced in emergency before radiography. The treatment consisted in orthopedic reduction and plaster 7 times, percutaneous kwire 2 times, immediate arthrodesis 5 times, open reduction and internal fixation with kwires 55 times. Post-operatively, 8 complications were noticed. 11 secondary arthrodesis were made with reference to failures of previous methods. They have been performed from 9 months to 5 years after the initial traumatism due to a painful ankylosis in bad position or arthrosis. The arthrodesis was total 6 times, partial lateral 2 times, partial medial 3 times. RESULTS: 63 patients were reviewed with a minimum follow-up evaluation of two years and a maximum of 9 years. The results show that we must reduce the tarsometatarsal fracture dislocations even if the displacement is minimal and we must fix them. The most satisfactory means seem to be open reduction if the least anatomical defect exists. Immediate, total arthrodesis reposition is suitable when an important articular comminution exists. If the total secondary arthrodesis reposition gives good results, its realization is sometimes difficult. The lateral partial arthrodesis must be discontinued, because they don't seem logical. The medial partial arthrodesis didn't prove its superiority, compared with total arthrodesis. DISCUSSION: The reduction of Lisfranc's dislocation is essential. The single case not unreduced has given a bad result as shown in the litterature. When the orthopedic treatment is well-made, the result is good. The open reduction followed by an axial fixation has only given 56 per cent of good results. The main reason of these bad results is an important comminution which should have practised an immediate arthrodesis reposition and a bad reduction. We must be aware on the quality of the anatomical reduction. The secondary arthrosis appeared principally in cases where the reduction was defective (13 observations out of 50). The 5 immediate arthrodesis have all given a good result. CONCLUSION: The retrospective study of the series teaches us to reduce the tarsometatarsal fractures dislocations even if the displacement is minimal and to fix them. We must make a wider place to the immediate arthrodesis reposition.

Accidents, Traffic↗
PubMed1997

[Recent palmar dislocations of the proximal interphalangeal joint].

PURPOSE OF THE STUDY: Recent anterior dislocations of the proximal interphalangeal (PIP) joint are uncommon injuries. Chronic and irreducible dislocations have been most often reported. This study aims to precise the anatomic and radiologic aspects of these lesions about three cases, and to compare these cases and their treatment with thirteen cases published in the literature between 1966 and 1994. MATERIAL AND METHODS: Three patients presented an anterior dislocation of the PIP joint after direct or twisting traumatism. One had an avulsion of the central slip of the extensor tendon and remained unstable after closed reduction needing pin fixation. Two had a longitudinal tear between central and lateral bands of the tendon with an entrapment of the condyle of the proximal phalanx, and the dislocations were irreducible. After open reduction, the joint was stable. RESULTS: The first case showed a limited flexion after three months. In the two other cases without rupture, full range of motion was recovered after two months. DISCUSSION: These cases have been compared with thirteen cases of recent papers from nine authors. Two types of anterior dislocations of the PIP joint may be described. TYPE I: Without rupture of the central slip fo the extensor tendon. One distal condyle of the proximal phalanx is entrapped between the central slip and a lateral band of the extensor tendon, that are separated by a longitudinal partial tear. The deformity is made by flexion, axial rotation and lateral displacement of the middle phalanx. Open reduction is required and may carry out good functional result. TYPE II: With rupture of the central slip of the extensor tendon. These very unstable lesions need a fixation after closed or open procedure. The treatment is often lately carried out, and the results not so good as in type I. CONCLUSION: Two different types of PIP joint anterior dislocations are described. Earlier diagnosis and surgical treatment can allow early rehabilitation and better final functional results.

Adult↗